Pre-Clinical Year Overview – Admissions 2019

Pre-Clinical Year Overview – Admissions 2019


– [Annamarie] My name
is Annamarie Stryline, Director of Pre-Clinical Education, and this is an overview
of the pre-clinical year at the Duke Physician Assistant Program. This is an overview of our
educational philosophy. We are well aware that the
Physician Assistant profession began at Duke, and ours
is the oldest program in the country. Although we are proud of
that heritage, we continue to take our responsibility
as leaders in the profession very seriously, and we
don’t rest on our laurels. This program has continuously
evolved to stay strong and effective at educating PAs. Our primary goal is to
prepare each student to be a professional
clinical PA practicing in primary care. We believe this is the most
comprehensive preparation we can provide and makes our graduates capable of practicing
in any clinical setting. Some choose specialty
practice over primary care. Many switch practice over
the course of their careers. We are a competency-based
curriculum which means that before a student
completes the program, we feel confident that they
are ready to practice medicine and the student feels competent as well. We expect each student to
attend all educational sessions. This is the best way for
each student to benefit from the rich clinical and life experience that their classmates
bring to the classroom. We encourage students to share
these unique perspectives. We discourage competition,
as we want every student to be successful. The Blue Cross Blue Shield
building is the current home of the PA program. We renovated this historic
facility to meet the needs of our students and have been
in this building since 2009. The land on which this building sits is part of established Durham history. The home of Eugene Morehead
sat here in the late 1800s. He was the son of John Motley Morehead, governor of North Carolina
from 1841 to 1845. In 1961, his house was
demolished to make way for the hospital care
building, which later became Blue Cross Blue
Shield of North Carolina. The PA program faculty is
one of our greatest assets. The faculty is made up
of certified clinicians in active clinical practice. We bring a wealth of clinical
and academic experience to the program. We are active participants in a number of professional organizations
at the institutional, local, regional, and
national level and many of us hold leadership roles
in those organizations. PA program faculty members
have a long history of leadership and service
to the PA profession, including with the Physician Assistant Education Association,
the North Carolina Academy of Physician Assistants
and with numerous PA specialty organizations. Most of the faculty are active clinicians which enriches our curriculum delivery, as we are part of an
academic medical center, we are also able to call on a
range of medical professionals from Duke Medical Center
to provide instruction in their areas of content expertise in a number of our
pre-clinical year courses. This is a simplified
overview of the current pre-clinical year curriculum, which begins in early August and runs through June, showing the fall,
spring, and summer terms. I will discuss each of the courses later in this presentation. The role of the pre-clinical
or first year of the program is to prepare our students for the second, or clinical year of the program. Our educational approach
builds upon students’ prerequisite coursework
and clinical experiences. It is based on the solid
foundation of a clear understanding of basic medical and clinical concepts, a strong fund of medical knowledge, and the development of essential
critical thinking skills. We provide course content that is based on sound medical
evidence, and we integrate the content across some
of our core courses. We provide a number of
learning opportunities intended to help students
put it all together, including traditional
lectures, required readings, individual assignments,
small group discussions, and the use of trained
actors who portray patients so students can practice
their history taking and physical exam skills before practicing on real patients. In addition, there are
a number of laboratory and simulation settings to
provide hands-on learning. Admitted students start
getting communications from the program many
months before matriculation. These include information
about required textbooks, medical equipment, and
fall course registration. In addition, there’s a
medical terminology assignment and summer reading that we ask students to complete in preparation
for beginning coursework. The program begins with a welcome session, including greetings from Duke
University Medical Center and the Department of
Community and Family Medicine. Leadership in those areas are represented. This is followed by introductions
of PA program faculty and staff members and of each new student. The welcome session is
followed by a multi-day technology orientation. During the technology
orientation, students receive their computer hardware
and are trained to use the software used in the PA program. The program provides the
technological resources, including hardware,
software, applications, and training, so you can make the most of your short time as a PA student. At the beginning of the
program, each student receives a laptop computer,
which has typically been Windows-based, and
an electronic tablet. We recommend you wait to find out where you’ll be attending PA
school before you purchase any new computers or mobile
devices, except a cell phone. Do not purchase these items
if you’re coming to Duke, as we will provide them. We are transitioning to
an integrated electronic textbook platform for most
of our required textbooks. The cost of this is included
in your technology fee. A few of the required
textbooks are not available through this platform and
must be purchased separately. Course-related documents
and resources are posted to Sakai, our current
learning management system for student access. Students typically use
their laptops to take lecture notes in our primary PA classroom which is fully outfitted
with video and audio. We also have digital displays
in our small-group rooms. In addition, students have
access to onsite printers. Most examinations and
all course evaluations are deployed electronically. We are able to record
students’ interactions with standardized patients in
our clinical performance exam or CPX spaces onsite
so students can review and improve their physical diagnosis and history taking skills
in a safe environment. In our on-site custom
diagnostic methods laboratory, students practice
performance of point-of-care laboratory tests and office procedures. We also have a number
of trainer simulators for practice of clinical
skills at the PA program. Students use the Duke
simulation lab on the main medical campus to
practice surgical skills. In addition to the technology orientation, the program moves forward with
some non-academic activities, including orientations to the
Duke and Durham communities, the PA program, and a
more extensive overview of the pre-clinical year than
what I am providing today. Second year students answer
questions about what it is like for them to be first-year students. WE hold an intimate White Coat Ceremony, in which each student’s faculty advisor helps them don their white
coat for the first time, signifying the beginning
of their formal preparation for the PA profession. We end the week with a welcome picnic. This is open to all first
and second-year students, their friends and families, and all staff and faculty members. Classes begin the following
week of the program but orientation-related
sessions about other student resources also continue. Some of these are related
to study strategies, promoting a culture of excellence in diversity and inclusion,
and an introduction to university-based resources. These are images of students
getting to know each other, the campus, and locating
important resources on their campus exploration
during orientation. The fall semester begins
with foundational courses in basic medical sciences,
physiology, and anatomy. Our students perform cadaver dissection at the state-of-the-art anatomy lab at the medical center. We have cadavers dedicated
for use by PA students with a ratio of four to
five students per cadaver. In the Patient Assessment
and Counseling One course, students learn how to
appropriately interact with patients, the current techniques for comprehensive history
and physical exam, and how to properly
document their findings for the medical record. In Evidence-Based Practice One, students learn how to read
and critically evaluate the medical literature
so they can appropriately apply that information in
the care of their patients. The Clinical Medicine, Diagnostic Methods, and Pharmacology courses are integrated for each medical discipline,
organized by body system. For example, during the Cardiology unit of the clinical medicine
course, students study the risk factors, etiology, symptoms, and physical exam findings for conditions such as heart failure. At the same time, students
learn the appropriate lab tests or imaging studies to diagnose and monitor that condition in
the diagnostic methods course and the appropriate medications
to treat heart failure in the pharmacology course. So in the fall, the
hematology, cardiology, and orthopedics units are
presented concurrently in these three courses. This is an image of one of the weekly physical diagnosis sessions in the Patient Assessment
and Counseling One course. A faculty member is pictured
teaching a small group of students in one of four
physical diagnosis rooms. Each includes a central conference table and six clinical exam tables. Students learn the proper
techniques for performing a comprehensive physical
exam by practicing on their classmates. In this picture, you can see the original Duke Hospital, mid-view brick building, as well as the top of Duke
Chapel in the background. There are many more clinics offsite. The pre-clinical year anatomy lab occurs in this space. After the end of the fall semester, we have a program break for several weeks. During this time, we
encourage students to rest, recharge their batteries, and spend time with family and friends. Classes restart during
the first week in January. The integrated units of Clinical Medicine, Diagnostic Methods,
and Pharmacology resume in the spring semester
with coverage of the units listed on this slide. There are periodic
synthesis sessions that help hone students’ critical thinking skills, appropriately use diagnostic tests, and develop a differential
diagnosis and treatment plan. In our onsite custom
diagnostic methods laboratory, students practice
performance of point of care laboratory tests and office procedures. In addition, PAC Two, Patient Assessment and Counseling, continues
and students begin taking histories and performing exams on hospitalized patients
under the direction of a PA. Students also learn to
make oral presentations and document their patient encounters. The Introduction to Prevention
and Population Health course introduces public health concepts related to maximizing health
at the population level. In the surgery course,
students learn about surgical instrumentation and
maintaining a sterile field, how to perform laceration repair
and other office procedures such as bandaging and casting,
pre- and postoperative patient care, and how to
function as a first assistant in the operating room. In the Practice and the
Health System course, students learn about the
US healthcare system, the framework within which PAs function as medical providers,
including recent reforms and payment mechanisms, public health, and healthcare economics. They also learn about the
history of the PA profession, legislation related to PA practice, PA professional
organizations, certification, licensing, and credentialing
and about other professions with which PAs
team to provide comprehensive patient care. There are multiple opportunities
for hands-on learning. These are images of
students learning heart and lung sounds with
one of our onsite Harvey cardiopulmonary simulators,
practicing suturing on pigs’ feet, an image of
the anatomy dissection space, and of the fresh tissue laboratory. The summer term has only four courses, which are all continuations
from fall and spring courses. The summer units of Clinical Medicine, Diagnostic Methods, and
Pharmacology are listed here. Patient Assessment and Counseling Three includes behavioral medicine
topics, patient education and counseling techniques, and dovetails with the psychiatry unit. The annual American Association
of Physician Assistants conference occurs during the summer term. We suspend classes so
interested students can travel to the conference, attend
educational sessions, network with practicing
clinicians and PA students from other programs, and
participate in student association activities
including the medical challenge bowl. The program provides
some financial support for students who attend. The amount depends on
the number of students who choose to attend. Generally, the majority
of the class will attend the conference each year. Some students choose to
take a break to spend time with family or friends
instead of attending. These are images of the Medical Library. Most student access these
resources electronically. In addition, we are very fortunate to have a dedicated medical library liaison who supports our PA
students’ research needs. We recognize that the pace
and rigor of PA school is challenging, and we want to provide the support needed to help our students not only survive but
to thrive here at Duke. Each student has a faculty
advisor who follows them throughout the program to provide support in routine, scheduled,
and as-needed meetings during both the pre-clinical
and clinical years of the program. The faculty advisors
provide academic oversight and assist with CV review, licensure, and employment references
in preparation for student transition to employment as a PA. In addition, our second-year
student mentor program involves rising second-year
students adopting an incoming student for a
peer mentoring relationship. These mentoring relationships
start prior to matriculation and continue as student needs evolve. Other resources for student
support include access to educational specialists,
the Duke Student Wellness Center, and counseling
and psychological services. We want to make sure
you realize that being a Duke PA student is not
just about learning medicine in the classroom, lab,
hospital, or clinic. Our students have a strong
record of volunteerism and community involvement while
they are in the PA program. We enthusiastically support
these student-led activities. Students have many
opportunities for leadership and community service
through the Stead Society, our Duke PA student governing body, as well as an interdisciplinary
team with students from other health
profession programs at Duke. For example, these are
images of recent classes participating in a
class-sponsored blood drive for the American Red
Cross, teaching hygiene to fourth graders at the
Burton Elementary School, and having their heads
shaved to raise money for pediatric cancer research with the Saint Baldrick’s Foundation. We hope this presentation
provided an informative and useful overview of
the pre-clinical year of the Duke Physician Assistant Program.

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